Health knowledge and self-efficacy to make health behaviour changes: a survey of older adults living in Ontario social housing.

BACKGROUND: Older adults living in social housing are a vulnerable population facing unique challenges with health literacy and chronic disease self-management. We investigated this population's knowledge of cardiovascular disease and diabetes mellitus, and self-efficacy to make health behaviour changes (for example, physical activity). This study characterized the relationship between knowledge of health risk factors and self-efficacy to improve health behaviours, in order to determine the potential for future interventions to improve these traits. METHODS: A cross-sectional study (health behaviour survey) with adults ages 55+ (n = 599) from 16 social housing buildings across five Ontario communities. Descriptive analyses conducted for demographics, cardiovascular disease and diabetes knowledge, and self-efficacy. Subgroup analyses for high-risk groups were performed. Multivariate logistic regressions models were used to evaluate associations of self-efficacy outcomes with multiple factors. RESULTS: Majority were female (75.6%), white (89.4%), and completed high school or less (68.7%). Some chronic disease subgroups had higher knowledge for those conditions. Significant (p < 0.05) associations were observed between self-efficacy to increase physical activity and knowledge, intent to change, and being currently active; self-efficacy to increase fruit/vegetable intake and younger age, knowledge, and intent to change; self-efficacy to reduce alcohol and older age; self-efficacy to reduce smoking and intent to change, ability to handle crises, lower average number of cigarettes smoked daily, and less frequent problems with usual activities; self-efficacy to reduce stress and ability to handle crises. CONCLUSIONS: Those with chronic diseases had greater knowledge about chronic disease. Those with greater ability to handle personal crises and intention to make change had greater self-efficacy to change health behaviours. Development of stress management skills may improve self-efficacy, and proactive health education may foster knowledge before chronic disease develops.

Design and rationale for a pragmatic cluster randomized trial of the Cardiovascular Health Awareness Program (CHAP) for social housing residents in Ontario and Quebec, Canada.

BACKGROUND: The Cardiovascular Health Awareness Program (CHAP) uses volunteers to provide cardiovascular disease (CVD) and diabetes screening in a community setting, referrals to primary care providers, and locally available programs targeting lifestyle modification. CHAP has been adapted to target older adults residing in social housing, a vulnerable segment of the population. Older adults living in social housing report poorer health status and have a higher burden of a multitude of chronic illnesses, such as CVD and diabetes. The study objective is to evaluate whether there is a reduction in unplanned CVD-related Emergency Department (ED) visits and hospital admissions among residents of social seniors' housing buildings receiving the CHAP program for 1 year compared to residents in matched buildings not receiving the program. METHODS/DESIGN: This is a pragmatic, cluster randomized controlled trial in community-based social (subsidized) housing buildings in Ontario and Quebec. All residents of 14 matched pairs (intervention/control) of apartment buildings will be included. Buildings with 50-200 apartment units with the majority of residents aged 55+ and a unique postal code are included. All individuals residing within the buildings at the start of the intervention period are included (intention to treat, open cohort). The intervention instrument consists of CHAP screens for high blood pressure using automated blood pressure monitors and for diabetes using the Canadian Diabetes Risk (CANRISK) assessment tool. Monthly drop-in sessions for screening/monitoring are held within a common area of the building. Group health education sessions are also held monthly. Reports are sent to family doctors, and attendees are encouraged to visit their family doctor. The primary outcome measure is monthly CVD-related ED visits and hospitalizations over a 1-year period post randomization. Secondary outcomes are all ED visits, hospitalizations, quality of life, cost-effectiveness, and participant experience. DISCUSSION: It is anticipated that CVD-related ED visits and hospitalizations will decrease in the intervention buildings. Using the volunteer-led CHAP program, there is significant opportunity to improve the health of older adults in social housing. TRIAL REGISTRATION: ClinicalTrials.gov,NCT03549845. Registered on 15 May 2018. Updated on 21 May 2019.

Choosing the most appropriate existing type 2 diabetes risk assessment tool for use in the Philippines: a case-control study with an urban Filipino population.

BACKGROUND: As the prevalence of type 2 diabetes (T2DM) increases in low- to middle-income countries, the burden on individuals and health care systems also increases. The use of diabetes risk assessment tools could identify those at risk, leading to prevention or early detection of diabetes. The aim of this study was to evaluate the appropriateness of 6 existing T2DM risk screening tools in detecting dysglycemia in Zamboanga City, Philippines. METHODS: This study used a case-control design in an urban setting in the southern Philippines. There were 200 participants in two groups: 1) those diagnosed with diabetes (n = 50; recruited from diabetes clinics) and 2) those with no previous diagnosis of diabetes (n = 150; recruited from community locations). Participants completed six tools (the Finnish Diabetes Risk Score [FINDRISC], the Canadian Diabetes Risk Score [CANRISK], the Indian Diabetes Risk Score [IDRS], the American Diabetes Association [ADA] risk score, an Indonesian undiagnosed diabetes mellitus [UDDM] scoring system, and a Filipino tool). Scores were compared to fasting plasma glucose levels, which are recommended in Philippines clinical practice guidelines as a valid, available, and low cost option for T2DM diagnosis. Appropriateness of tools was determined through accuracy, sensitivity, specificity, positive/negative predictive value (PPV, NPV), and positive/negative likelihood ratios. RESULTS: The Filipino tool had the highest specificity (0.73) and PPV (0.27), but lowest sensitivity (0.68). The IDRS and Indonesian UDDM tool had the highest NPV at 0.96, but were not amongst the highest in other scores. The CANRISK tied for highest area under the receiver operating characteristic (ROC) curve (AUC), AUC (0.80), but other scores were not noteworthy. Overall, the FINDRISC was the most effective with highest sensitivity (0.94), tied for highest AUC (0.80), and with middle scores in other variables (specificity: 0.45, PPV: 0.20, NPV: 0.95), when using the published cut-off score of 9. When increasing the cut-off score to 11, specificity increased (0.71) and sensitivity was not greatly affected (0.86). CONCLUSIONS: Our results suggest that the FINDRISC is more suitable than other known diabetes risk assessment tools in an urban Filipino population; effectiveness increased with a higher cut-off score.

Choosing the optimal method of blood pressure measurement for limited-resource rural communities in the "Community Health Assessment Program-Philippines".

The Community Health Assessment Program-Philippines (CHAP-P) is an international collaboration of investigators whose aim is to adapt a previously proven Canadian community-based cardiovascular awareness and prevention intervention to the Philippines and other low-middle-income countries. Choosing a method of blood pressure measurement for the research program presents a challenge. There is increasing consensus globally that blood pressure measurement with automated devices is preferred. Recommendations from low-middle-income countries, including the Philippines, are less supportive of automated blood pressure devices. The value placed on factors including device accuracy, durability, cost, energy source, and complexity differ with local context. Our goal was to support the progress of local policy concerning blood pressure measurement while testing a comprehensive approach to community-based screening for cardiovascular risk. The authors describe the challenges in making a choice of blood pressure device and the approach to determine optimal method of measurement for our research program.

Pharmacological characterization of venoms from three theraphosid spiders: Poecilotheria regalis, Ceratogyrus darlingi and Brachypelma epicureanum

Background Tarantulas (Theraphosidae) represent an important source of novel biologically active compounds that target a variety of ion channels and cell receptors in both insects and mammals. In this study, we evaluate and compare the pharmacological activity of venoms from three taxonomically different theraphosid spiders bred in captivity: Poecilotheria regalis, an aggressive arboreal tarantula from southeastern India; Ceratogyrus darlingi, an aggressive tarantula from southern Africa; and Brachypelma epicureanum, a docile tarantula from the Yucatan dry forest of Mexico. Prior to this study, no research had been conducted with regard to the composition and pharmacological activity of these venoms. Methods The pharmacological characterization of the venoms was described for the first time by the assessment of their toxicity in crickets (LD50) along with their nociceptive (by using the formalin test), hyaluronidase, phospholipase A2, edematogenic and caseinolytic activity. Results P. regalis and B. epicureanum venoms induced a similar lethal effect on crickets (LD50 = 5.23 ± 3.1 and 14.4 ± 5.0 μg protein/g 48 h post-injection, respectively), whereas C. darlingi venom (119.4 ± 29.5 μg protein/g 48 h post-injection) was significantly less lethal than the other two venoms. All three venoms induced similar edematogenic activity on rats but did not induce nociceptive behavior. The assessment of enzymatic activity indicated that P. regalis venom induces significantly higher hyaluronidase activity (27.6 ± 0.9 TRU/mg) than both C. darlingi (99.7 ± 1.9 TRU/mg) and B. epicureanum (99.6 ± 1.6 TRU/mg); these latter venoms did not display phospholipase A2or caseinolytic activity. Conclusions This study demonstrates that these theraphosid spiders of different habitats produce venoms with different activities. P. regalis venom displays a high level of hyaluronidase activity, which may be associated with its potentially medically significant bite.

Pharmacological characterization of venoms from three theraphosid spiders: Poecilotheria regalis, Ceratogyrus darlingi and Brachypelma epicureanum

BackgroundTarantulas (Theraphosidae) represent an important source of novel biologically active compounds that target a variety of ion channels and cell receptors in both insects and mammals. In this study, we evaluate and compare the pharmacological activity of venoms from three taxonomically different theraphosid spiders bred in captivity: Poecilotheria regalis, an aggressive arboreal tarantula from southeastern India; Ceratogyrus darlingi, an aggressive tarantula from southern Africa; and Brachypelma epicureanum, a docile tarantula from the Yucatan dry forest of Mexico. Prior to this study, no research had been conducted with regard to the composition and pharmacological activity of these venoms.MethodsThe pharmacological characterization of the venoms was described for the first time by the assessment of their toxicity in crickets (LD50) along with their nociceptive (by using the formalin test), hyaluronidase, phospholipase A2, edematogenic and caseinolytic activity.ResultsP. regalis and B. epicureanum venoms induced a similar lethal effect on crickets (LD50 = 5.23 ± 3.1 and 14.4 ± 5.0 μg protein/g 48 h post-injection, respectively), whereas C. darlingi venom (119.4 ± 29.5 μg protein/g 48 h post-injection) was significantly less lethal than the other two venoms. All three venoms induced similar edematogenic activity on rats but did not induce nociceptive behavior. The assessment of enzymatic activity indicated that P. regalis venom induces significantly higher hyaluronidase activity (27.6 ± 0.9 TRU/mg) than both C. darlingi (99.7 ± 1.9 TRU/mg) and B. epicureanum (99.6 ± 1.6 TRU/mg); these latter venoms did not display phospholipase A2or caseinolytic activity.ConclusionsThis study demonstrates that these theraphosid spiders of different habitats produce venoms with different activities. P. regalis venom displays a high level of hyaluronidase activity, which may be associated with its potentially medically significant bite.(AU)